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characterized anatomically_by a cellular into a yellow, cheesy mase. The degeneinfiltration which subsequently caseates, rated tubercles next unite and form the softens, and leads to ulceration of the uniform cheesy mass so commonly seen at lung-tissue. The clinical manifestations autopsies. are wasting, exhaustion, hectic fever and Here one of two things may occur: The cough.
mass may soften and break, being evacuAmong the predisposing factors may be ated thru a bronchial tube, leaving a cavmentioned: Heredity; age; occupations ity with ulcerating walls; or a growth of necessitating the breathing of impure air, connective tissue may form around it, and or air containing irritants, such as dust, calcification later ensue. In addition, the iron-filings, etc. ; residence in low, damp lung-tissue in the vicinity of these prolocalities; catarrhal inflammation and cesses is often the seat of a pneumonic intraumatism of the lungs; physique ; gen- flammation; the connective tissue is aleral diseases which lower the vitality. ways more or less proliferated; the bronThese matters can be more fully elaborated chial tubes are inflamed ; and the pleure in order to fully understand the develop- over the areas affected are nearly always ment of the disease.
adherent. The pathology is of importance, since The infective process usually begins at along this line investigations can most accu- the apexes of the lungs. rately be made. In the examination of In the acute form, sometimes called tuberculous tissues the bacillus tuberculosis cheesy pneumonia, acute phthisis, phthisis is invariably found, alone or associated florida, or chronic catarrhal pneumonia, with other microorganisms. It is a very the process is invariably tuberculous, altho minute rod, about one-fourth or one-half the attack may be terminated in a period as long as a red blood-corpuscle. It is varying from a few weeks to a few months. often slightly bent or beaded, and for This rapidity is generally the result of exabsolute determination depends upon its treme vulnerability of the tissues, permitpower to resist decolorizing acids. An
An ting rapid infiltration. oil-immersion lens is necessary for satis- In some cases the lungs are solidified by factory examination.
a dense yellowish-gray infiltration, which When the bacillus is lodged in the term- the microscope will show to be composed inal bronchioles of the apex of the lungs of closely-aggregated tubercles. In other a proliferation of the fixed cells is excited, cases the consolidation appears in more or and these become somewhat polygonal in less discrete patches which have had their shape. These are termed epithelioid cells, origin in the smaller bronchial tubes ; in and often contain bacilli. Giant-cells are a third form one or both of the lungs are the next step, formed by the fusion of studded with discrete tubercles, many of these cells or by the overgrowth of indi- which are still gray and translucent. vidual cells.
In the variety termed fibroid phthisis, This aggregation of new cells has an the lung-tissue appears to be resistant, irritative effect, and the natural result of and the process is limited by an overthe formation of a surrounding wall of growth of connective tissue, forming dense leukocytes soon follows. This constitutes bands around the foci of infection. This the gray tubercle of Laennec, a gray, is a very gradual form of the disease, and translucent mass, with the new cells
lasts many years.
It has been known in centrally situated in the surrounding mass some sections as “old folks' consumpof white blood-cells. The next step in the tion,” since its existence has been demonprocess is the usual coagulation-necrosis, strated in persons of advanced age, who starting in the center, and spreading to give a history of having long had the dis the periphery, and converting the tubercle ease in this slowly progressing form.
have been taken even in this city directed The profession is watching with grave against this measure. Even a writer of concern the increasing number of cases of such mark as Alfred Russell Wallace has smallpox, together with the recrudescence publisht an argument ingenious in con
Comparative mortality per 100,000 from smallpox in Prussia and in Austria in the twenty years from 1865 to 1884.
revaccination was made obligatory in Prussia.
of antivaccination ideas. The opposition struction, and apparently without sophishas not yet become so markt in this coun- try, in which he claims that vaccination try as in England, but among a certain is a delusion, number of pseudo-scientists overt steps
That those who are interested in anti
vaccination are so sincere in their oppo- lation upon this point.
The dark areas sition only renders the matter more grave. represent the proportionate number of Was the agitation inaugurated merely cases, and the weight of evidence is too with the intent to gain public notice and great, and the result too apparent, to not from a conviction, however mistaken, require comment. of right, the evil could be better dealt In this connection a few admonitory with. In this connection is the fact that, words to those who are interested in medmaking all due allowance for timidity and icine and who come within the scope of newspaper sensationalism, more small- our influence may not be amiss. To all pox prevails in the United States to-day such we would say, use all your influence than for many years, and this despite to promote early resort to vaccination as the conceded advance in public and the only trustworthy means of protection. private hygiene to which the antivacci- Revaccination will make the matter pos
Dationists attribute all the decrease in itive beyond peradventure, and this should the death-rate from this sometime scourge be done whenever there is any doubt about of humanity.
the efficacy of the original vaccination or In this connection we append two dia- when a considerable time has elapst. Facts grams, for the use of which we are indebted bearing upon this matter can readily be to the courtesy of the Philadelphia Medical obtained, a notable instance being the Journal, and which will show at a glance, supplementary Health Report, issued by and better than any array of words, the the Marine-Hospital Service, January 6, effects of compulsory vaccination. These 1899. Among other points forcibly brought are in the form of comparison of cases oc
out is that in 1871, Germany, with a popcurring before and subsequent to the inaug- ulation of about 50,000,000 lost 143,000 uration of the compulsory system of lives by smallpox. In 1874 vaccination was vaccination in the countries represented, made compulsory, and last year only 116 and also a comparison of the rates between deaths were reported from an increast Prussia and Austria, with differing legis- population. This is also illustrated most
clearly by the accompanying diagrams In fatal cases such complications as before referred to.
capillary bronchitis, catarrhal pneumonia, The ravages of smallpox among the and pulmonary collapse are frequently unvaccinated residents of Montreal begin- observed. ning February, 1895, and raging until the The period of incubation is usually about close of the year, during which thousands two weeks and the attack is generally were stricken with the disease and 3,164 ushered in by prodromes of chilliness, died, is yet fresh in the minds of many of coryza, watering of the eyes, complaint of us. Particulars of this are given in Osler's the light hurting the eyes, cough, and Practice of Medicine.
drowsiness. This prodromal period lasts The objections to vaccination on the about three days. Usually the fever, score of impurity of the lymph are no which had risen rapidly at the beginning longer valid since the perfection of glycer- of the prodromal stage to 102° or 104 inated vaccine-lymph, which is far more shows on the second or third day a decided aseptic and active and less calculated to remission which generally continues until induce inflammations than the old-fash- the fourth day when the eruption appears. jioned “points." In the most approved The temperature now may reach so high brands that are on the market the virus is as 105°, at least considerably higher than put up and produced under aseptic pre- at the first, and may remain at this height cautions not less stringent than those the for several days, falling either by crisis or modern surgeon employs in a major opera- lysis. Desquamation lasts about 14 days. tion. Every parcel is tested physiologically The pulse is generally from 140 to 160 per and is put up in hermetically sealed capil- minute and is full and bounding. lary tubes which effectually exclude germ- A point in diagnosis is the development contamination,
of the so-called Koplik sign, the appearance on the buccal mucous membrane of
small irregular red spots with a bluishMeasles.
white center. They are to be differentiaThis acute contagious disease is chiefly ted from the reddened mucous membrane characterized by catarrh of the respiratory of scarlet fever, the large white spots of tract, a moderate fever, and a red papular thrush, and the sore mouth of stomatitis. eruption which appears on the fourth day They do not appear in rotheln. They and terminates in about 60 or 70 hours by should be lookt for in a good light. They branny desquamation.
lose their peculiarities as the skin becomes The method of its transmission has not involved in the eruption, and merge into a been definitely determined, but it is known more diffuse redness which entirely disapto be transmitted thru the clothing and pears before the skin has returned to its other fomites. The bacillus determining normal state. the disease has not been isolated, and un- The rash of measles is more dusky than til this is determined its modes of action that of scarlet fever. It appears first in cannot be definitely defined. It is most macules upon the forehead or face, then commonly observed in children, but un- upon the neck, trunk, and limbs in the orprotected adults are also likely to be der named. The macules, which often affected. One attack is fairly protective, coalesce, are arranged in crescents which but does not confer positive immunity. It are slightly raised and red, but become is essentially an epidemic disease, but now somewhat yellowish on pressure. There and then sporadic cases will occur.
is nearly always seen to be some uninThe lesions consist chiefly in catarrh of volved skin, the entire surface not being the entire respiratory tract, and gastro- covered as in scarlet fever intestinal catarrh is not uncommon. To differentiate measles the following
points in diseases resembling should be The prognosis should be guardedly favorborne in mind.
able, this because complications which Rotheln: The prodromes are often ab. would lead to a fatal result are quite possent; the fever and the catarrh are slight; sible. and the sore throat is markt. The rash
Treatment of Diphtheria. appears on the first or second day as a dif- There has been but little discussion for fuse red blush or as small pale-red spots some time past upon the methods to be which do not form crescentic-shaped used in the various stages of this disorder patches; the desquamation is scarcely no- that has not centered around the matter ticeable.
of antitoxin, for and against, with a conScarlet-fever: The fever is high and stantly increasing weight in favor of its lacks the pre-eruptive remission; sore Yet it must be conceded that the throat is present instead of general ca- degree of advance in favor of the serum tarrh; the eruption appears on the first or treatment is not so high as has been anticsecond day as a diffuse punctiform rash; ipated by those interested in the progress the pulse is out of proportion to the fever; of medical science. This may possibly be and this a much greater tendency to due to the fact that not all makes of serum nephritt
are standardized in the same way, and Measles is by no means the trivial dis- that hence an element of doubt exists as order it is usually considered. Even in to the relative strengths of the preparamild cases want of care may result in a tions supplied by the different makers. serious danger during the acute stage, or Statistics are conscientiously and conmay lead to a complication that may be sistently gathered as to the effect of the fatal or leave the patient with some serious use of the serum, with varying results, chronic affection. Every case should which, however, seem to be relatively detherefore be seen by a physician as soon terminable by readily accessible means of as possible, and be cared for by an expe- comparison. For instance, an analysis by rienced nurse.
a disinterested chemist would give the The usual idea that it is well to expose relative strength of the preparations in children to the measles in order that they use in this country, thus affording data as may have it and “have them over with,” to the amount to be injected of each in should by all means be discouraged. This any given case to produce a given effect. arises out of the popular idea that the dis- Again, a comparison can be, and has been, ease is more severe in its manifestations in made as to the degree of the efficacy of children of more advanced years or in the serum at different stages of the develadults than in infants, This notion is not opment of the disease, and this would be susceptible vi proof, however,
a most valuable index as to its use. Altho the diagnosis of measles is usually As a result of the treatment (according easy if the case has been seen from the be- to investigations conducted by the Ameriginning of the catarrhal stage, there are can Pediatric Society and a number of certain possibilities of error that should be home and foreign Boards of Health, acting carefully guarded against. This is true and co-operating with various hospitals), particularly of small-pox, and error can the death-rate for this disease has been reonly be avoided sometimes by a careful in- duced from 10 to 15 per cent. below the vestigation of all the possibilities of infec- lowest figures quoted previous to its intion, and, by watching the course for a troduction, and where the cases were seen few days, care being taken to institute early in the disease, the antitoxin being such treatment, hygienic and otherwise, as given before the fifth day, the death-rate will give the greatest protection to all has fallen, in hospitals, to so low as 5 per concerned,
cent. of the number of cases treated. Still,